After the last wave in March and April, there has been a sustained period of extremely low Covid infection rates in the UK over the summer – so much so that it has felt like the virus has finally gone. The relief in society at large has been palpable. The only things that might adversely affect schools and hospitals now are industrial unrest and disintegrating 1970s concrete.
The sense that the pandemic is over was reinforced by the downgrading of the autumn vaccination programme. While boosters are still being made available to health and social-care workers and the clinically vulnerable, age eligibility has been restricted to the over-65s, whereas last year anyone older than 50 could get a shot. And the government slashed the fee for administering the jab, leaving many GP practices wondering if it was economically feasible even to take part in the campaign.
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The messaging – that Covid is much less of a concern – was still being digested by GPs when there was a remarkable volte-face. The government abruptly bumped up the vaccination fee again, but only if surgeries started vaccinating quickly. The sudden urgency comes amid signs that a new wave is under way earlier than anticipated. The Office for National Statistics Covid Infection Survey, which used to give reliable estimates of rates of infection in the community, was disbanded in March. But many, perhaps most, readers will know someone who’s come down with Covid again in the past few weeks. And what objective data we do still have – hospital admissions and death rates – confirm the anecdotal reports that infections are on the rise.
Isn’t this, though, what was expected? As the virus and the population evolve into a state of coexistence, Covid will become just another endemic illness akin to flu, with a wave every autumn and winter followed by a lull during the rest of the year. So why the sudden edginess in government quarters?
The answer is: we don’t yet trust the virus not to pull a nasty trick out of the evolutionary hat. We are starting to see cases of a new, highly mutated Omicron descendant called Pirola. This has been detected in numerous countries in Europe, North America, Africa and Asia, implying efficient transmissibility. And some of the UK cases to date have had no relevant travel history, suggesting Pirola is already making its way through the community here.
Although nobody yet knows whether 30-odd Pirola mutations will be able to evade the immunity built up by jabs and past infections, they are less likely to succeed when faced with an immune response that has been recently heightened by a booster shot. Hence the sudden imperative to crack on with vaccinating.
There is no prospect of a return to the social restrictions of yesteryear. While the first lockdown in March 2020 aborted an unfolding crisis beyond most people’s imagination, there is a growing appreciation that the side-effects of subsequent restrictions – on psychological health, economic activity and the management of non-Covid illness – exacted a disproportionate toll. The amount of population immunity that’s been built up through successive vaccination campaigns and prior infections should continue to limit severe disease and deaths, though it will not prevent infection.
As a society we are stuck in a no-man’s land. We remember with a collective shudder the exigencies of social restrictions and mandatory mask-wearing and seem determined not to yield to any measure, however benign, that might look like we’re in any way perturbed about the virus. The coercion on parents to enforce 100 per cent school attendance has returned with a vengeance, teaching children that transmission of infectious illness to others is not a concern, and nor is rest and recuperation a sensible idea when unwell. In the workplace, too, viruses are once again being brought in to be shared around.
People who still wear masks are frequently stigmatised. Policies that could have put in place measures like enhanced ventilation, shown to minimise indoor transmission, have never been enacted. To the hundreds of thousands of people affected by long Covid, so many of whom previously enjoyed robust good health and economic productivity, this will seem reckless. Long Covid has never featured in the governmental calculus as to the true impact of the pandemic, mainly because data on its incidence have never been collected. But it is there in the statistics all the same, buried among the swollen numbers of people off work with long-term sickness and claiming disability benefits, many from the health and social care sectors.
Most concerningly, the NHS no longer has a consistent policy for infection control. Hospital colleagues with Covid over the past few weeks report bizarre guidance: stay away if you have a high temperature or feel unwell, but otherwise it’s up to the individual to decide whether to come in. Vaccination may have reduced rates of severe illness and death, but where it still occurs is among the elderly and those with co-morbidities – people found in great numbers in healthcare settings. In wider society, it has become anathema to suggest we’re doing anything other than blithely “living with Covid”. Within the NHS we owe it to patients to continue to treat the virus with the respect it deserves.
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